Page 43 - herina surgery and possible lawsuits

Granulomas normally form around individual mesh fibers as part of the
foreign body reaction. Bridging describes the process whereby individual
granulomas become confluent with each other and encapsulate the entire mesh

(Figure 15).[82]
This leads to a stiff scar plate and reduced flexibility. It occurs in meshes with
small pores of less than 800 pm.

• Lightweight larger pore size mesh results in better tissue in-growth and lower
foreign body reaction, provides optimal flexibility for improved physical
properties, allowing a better activity profile post-surgery, but may lead to a

higher risk of adhesions.[83]
• It seems 2.5 mm pore size is ideal for monofilament mesh, although some
authors recommended pore sizes as large as 3 and 6 mm.[84]

< 1 mm

M, microfilament [13 Granuloma

Figure 15: Granulomas, bridging and encapsulation of entire mesh.[82]

iii. Strength: The tension placed on the abdominal wall can be calculated by the

law of Laplace which states that ‘in an elastic spherical vessel (abdomen), the
tension, pressure, wall thickness and diameter.

Laplace Law
Tension = (Diameter x Pressure)
(4 xWall thickness)

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